Eye Exams and Prescription Glasses: Coverage Limits

Eye Exams and Glasses in Germany: Insurance Coverage Limits

Does GKV cover eye exams?

• Yes, but with conditions:

  • Eye doctor exam: covered if symptoms or suspected disease.

  • Routine optician test: not covered, self-paid. ➡️ Direct visit to ophthalmologist allowed.

Does GKV cover glasses?

• Only in specific cases (since 2017):

  • Near-/farsightedness ≥ 6 diopters → partial lens cost

  • Astigmatism ≥ 4 diopters → lenses only, no frame

  • Children < 18 → lenses + frame fully covered

  • Post-surgery → exceptional cases only

Financial Support (Festbetrag)

• Simple plastic lenses: €10–30 per lens

• Special lenses (UV, coatings): usually not covered

• Multifocal lenses: not covered ➡️ Patient pays difference (Zuzahlung).

How to claim?

• Get prescription (Brillenverordnung) from ophthalmologist

• Submit at certified optician → insurer processes claim

• Patient pays only above fixed rate

Private Insurance (PKV)

• Usually covers exams + glasses + lenses

• Often €300–600 every 2 years depending on contract.